Herbst Tim, Emmert Martin
nordBLICK Augenklinik Bellevue, Lindenallee 21-23, 24105, Kiel, Germany.
Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403, Nuremberg, Germany.
BMC Health Serv Res. 2017 Jun 5;17(1):385. doi: 10.1186/s12913-017-2333-x.
To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology.
A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists.
Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing.
Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.
识别、描述和比较现有的绩效薪酬方法及其对眼科医疗质量和效率的影响。
进行了一项基于证据的系统综述。在以下数据库中检索了2000年至2015年期间以英文、法文和德文撰写的文献：Medline（通过PubMed）、NCBI网站、Scopus、Web of Knowledge、Econlit和Cochrane图书馆。纳入了实证性以及描述性文章。实证性文章包括对照临床试验、荟萃分析、随机对照研究以及观察性研究。根据“质量激励措施实施与监测模型”（MIMIQ）对已识别的绩效薪酬方法（P4P方法）进行系统描述。根据批判性评估技能计划（CASP）清单评估实证性文章的方法学质量。
总体而言，纳入了13篇相关文章。11篇文章为描述性文章，2篇文章包括实证分析。基于这些文章，确定了美国实施的四种不同的绩效薪酬方法。在质量和激励因素方面，系统比较显示P4P方法之间存在许多差异。实证研究显示了单独的成本或质量效应，但缺少对这些效应的同时考察。
研究结果表明，眼科领域绩效薪酬方法的经验有限。已识别的方法在质量和激励因素方面存在差异，限制了可比性。两项实证研究不足以就这些方法的有效性和效率得出强有力的结论。
